            <table cellpadding="3" cellspacing="0" border="0">
              <tr>
                <td><label for="<?php e($ext); ?>title"><?php __('Title'); ?>:</label></td>
                <td><input type="text" id="<?php e($ext); ?>title" name="title" class="validate[required,length[2,20]]" style="width:80px;" /></td>
              </tr>
              <tr>
                <td><label for="<?php e($ext); ?>first_name"><?php __('First Name'); ?>:</label></td>
                <td><input type="text" id="<?php e($ext); ?>firstname" name="firstname" class="validate[required,length[2,50]]" /></td>
              </tr>
              <tr>
                <td><label for="<?php e($ext); ?>last_name"><?php __('Last Name'); ?>:</label></td>
                <td><input type="text" id="<?php e($ext); ?>lastname" name="lastname" class="validate[required,length[2,50]]" /></td>
              </tr>
              <tr>
                <td><label for="<?php e($ext); ?>street"><?php __('Street'); ?>:</label></td>
                <td><input type="text" id="<?php e($ext); ?>street" name="street" class="validate[optional,length[2,255]]" style="width:210px;" /></td>
              </tr>
              <tr>
                <td><label for="<?php e($ext); ?>city"><?php __('City'); ?>:</label></td>
                <td><input type="text" id="<?php e($ext); ?>city" name="city" class="validate[optional,length[2,50]]" style="width:210px;" /></td>
              </tr>
              <tr>
                <td><label for="<?php e($ext); ?>state"><?php __('State'); ?>:</label></td>
                <td><input type="text" id="<?php e($ext); ?>state" name="state" class="validate[optional,length[2,50]]" /></td>
              </tr>
              <tr>
                <td><label for="<?php e($ext); ?>zip_code"><?php __('Zip Code'); ?>:</label></td>
                <td><input type="text" id="<?php e($ext); ?>zip_code" name="zip_code" class="validate[optional,length[2,20]]" /></td>
              </tr>
              <tr>
                <td><label for="<?php e($ext); ?>country"><?php __('Country'); ?>:</label></td>
                <td><input type="text" id="<?php e($ext); ?>country" name="country" class="validate[optional,length[2,50]]" /></td>
              </tr>
              <tr>
                <td><label for="<?php e($ext); ?>phone"><?php __('Phone'); ?>:</label></td>
                <td><input type="text" id="<?php e($ext); ?>phone" name="phone" class="validate[required,length[7,20]]" /></td>
              </tr>
              <tr>
                <td><label for="<?php e($ext); ?>email"><?php __('E-mail'); ?>:</label></td>
                <td><input type="text" id="<?php e($ext); ?>email" name="email" class="validate[optional,custom[email]]" style="width:210px;" /></td>
              </tr>
              <tr>
                <td><label for="<?php e($ext); ?>notes"><?php __('Reference'); ?>:</label></td>
                <td><input type="text" id="<?php e($ext); ?>notes" name="notes" style="width:210px;" /></td>
              </tr>
            </table>